Compression Levels Explained (15–20 vs 20–30 vs 30–40 mmHg): Who Needs What—and Why

Compression levels explained—in plain language. If you’ve ever wondered whether 15–20, 20–30, or 30–40 mmHg is right for you or your patients, this quick primer breaks down what those numbers actually mean, how gradient pressure supports lymph and venous return, and when to step up—or down—based on stage, tissue quality, and daily demands. We’ll compare common day garments (circular- vs flat-knit), look at why legs often need firmer containment than arms, and clarify where wraps and night garments fit. Most importantly, you’ll learn how to choose the lowest effective level that maintains reduction and comfort—in partnership with a Certified Lymphedema Therapist.

• mmHg = millimeters of mercury, the same unit used for blood pressure.
• Graduated compression means higher pressure at the wrist/ankle tapering upward. This gradient gently counters hydrostatic pressure, supports the lymphatic and venous pumps, and limits re-accumulation between therapy sessions.
• The right level depends on diagnosis, stage, limb, tissue quality, tolerance, and goals (reduction vs maintenance), plus safety considerations (skin integrity, arterial sufficiency, cardiac status, neuropathy).

While this guide focuses on pressure levels, keep in mind:

• Flat-Knit garments are stiffer, resist stretching into skin folds, and often work better for shape control and stage II+ lymphedema.
• Circular-Knit tends to feel softer and is common for milder presentations and athletic wear.

• Adjustable wraps (Velcro®-type) are great for self-management, fluctuating limbs, or when donning a sleeve is difficult.
• Night garments (foam/channeled) are separate tools—don’t confuse their sizing or expectations with day compression.

What it is: The lightest commonly available medical compression level. Often labeled “mild,” sometimes used in sports/air travel such as Jobst Sport Socks.

Best for:

• Very Early/Mild Edema or a limb with low daytime demand after successful reduction
• Prevention in at-risk limbs (e.g., air travel after lymph node procedures) when a clinician recommends it
• People transitioning into compression who need to build tolerance

Often not enough for: Established lymphedema that rebounds during the day; stage I–II cases usually require at least 20–30 mmHg for maintenance.

Why/When to Choose: Comfort, adherence, and lifestyle trump theory; if a patient can truly maintain volume and activity in 15–20 mmHg without end-of-day rebound, it’s acceptable. Otherwise step up.

What it is: The most commonly prescribed day-time level for upper-extremity lymphedema maintenance and for many mild–moderate lower-extremity cases (once reduced). Examples include Juzo Soft Arm Sleeves and Juzo Soft Stockings.

Best for:

• Stage 0–I and many stage II presentations after decongestive therapy
• Upper-Extremity Maintenance (post-breast-cancer-related lymphedema)
• Daily Wear when patients need a balance of effectiveness and comfort
• Post-Operative or Post-Injury edema when compression is advised by the care team

May be insufficient for: Persistently fibrotic tissues, frequent end-of-day rebound, or heavier lower-extremity disease—these often benefit from 30–40 mmHg or stiffer fabric.

Why/When to Choose: Start here for many UE cases: it’s effective, more wearable than higher levels, and easier for patients to don/doff consistently.

What it is: A higher, firmer therapeutic level. Often paired with flat-knit or adjustable wraps when shape control is needed. Solaris ReadyWrap Calf is a great example of a firmer adjustable wrap.

Best for:

• Stage II lymphedema with rebound in 20–30 mmHg
• Lower-Extremity lymphedema (gravitational load is higher)
• Fibrotic Tissue or skin folds where stiffer containment helps
• Phlebolymphedema (venous + lymphatic) when arterial status is adequate

Be cautious with: Donning difficulty (consider donning aids/wraps), sensory neuropathy, fragile skin, and thermoregulation issues. Always re-check perfusion and comfort.

Why/When to Choose: When containment and all-day control are priorities and the patient can safely tolerate the higher force.

Use Case: Selected severe lymphedema (often lower limbs), significant fibrotic change, or cases that clearly fail lower levels—only after clinical assessment. Often custom flat-knit or structured wraps like the CircAid Juxta-Fit Essentials Leg Wrap.

Caution: Increased risk of discomfort, donning challenges, and potential problems if arterial supply is marginal. Should be clinician-directed and re-evaluated regularly.

• Hydrostatic load: Gravity makes distal leg pressure management harder, especially with prolonged standing or heat.
• Tissue mass: Calf/thigh compartments often require stiffer containment than arms.
• Gait & shear: Walking introduces shear forces; sturdier fabrics hold shape better.

Result: A patient who does well in 20–30 mmHg on the arm may need 30–40 mmHg (and/or stiffer fabric) on the leg to achieve the same clinical effect.

Think in terms of Therapeutic Goals:

1. Reduction Phase (with bandaging, MLD, exercise): use multi-layer short-stretch bandaging or adjustable wraps to decongest and reshape.
2. Transition: trial of day-time sleeve/stocking at the anticipated maintenance level.
3. Maintenance: confirm the chosen pressure prevents rebound through the full day and is tolerable for the patient’s routine (work, travel, heat).
4. Tune-ups: adjust fabric, style, or level if swelling increases—earlier rather than later.

• Acute infection (cellulitis) or suspected DVT
• Uncompensated heart failure or acute cardiopulmonary decompensation
• Significant peripheral arterial disease (e.g., low ABI)
• Severe neuropathy or fragile/ulcerated skin that cannot tolerate shear

• Check daily for redness, pressure marks, numbness, tingling, pain.
• If the top band rolls or the wrist tourniquets, the size/length/fabric—or the level itself—may be wrong.
• Don’t jump levels to solve a fit problem; solve fit (measurement, fabric, style) first.

1. Clinical Picture: stage, region (UE/LE), tissue feel, girth profile, skin status.
2. Functional Day: job demands, sitting/standing ratio, heat/exercise profile, dexterity.
3. Trial & Verify: start at the lowest likely effective level, re-measure at end of day or after typical activity; if rebound or symptoms persist, step up level or stiffen fabric.
4. Educate for Self-Audit: teach patients to look for rebound cues (shoe feels tight, sleeve line marks, heaviness) and to report early.

• Patients: Work with a Certified Lymphedema Therapist to determine the safest, most effective level for your limb. Use Norton School’s Therapist Referral to locate a CLT in your area.
• Clinicians: Want deeper mastery of compression selection, fitting, and CDT? Explore Norton School’s comprehensive Lymphedema Certification (CDT) courses and advanced workshops.

This article is educational and not a substitute for medical advice. Compression levels and garment selection should be made with a qualified clinician who knows your history, skin, and arterial/cardiac status.